“I’m Not Giving It Away”
I had been listening to the technician talking on the telephone. She kept saying, “I don’t know.” Then she said, “That’s not our business. That is between the boy’s mother and her insurance company.”
There was a long pause. The technician pronounced each word carefully and with some force, “Doctor…I told you.. I DO NOT KNOW. That is not our job. We do not set prices.”
Another pause, then… “I AM DONE TALKING WITH YOU. HERE IS THE PHARMACIST.” She handed me the phone.
I got to the doctor first, before she could get to me. “Doctor, what is the problem? I was listening to the technician and she is right. We do not set copay prices.”
“Three hundred and sixty-five dollars? Isn’t that ridiculous?”
“If that is the copay it IS ridiculous. The patient’s mom needs to get different insurance, complain to her employer or…..”
“I want the generic, but that WOMAN told me that she can’t give the generic. Why is that?”
I took a second to ask, then back to the fray. “There is no generic available for Pulmicort Respules.”
“That’s ridicuolous. It is budesonide. You are a pharmacist. You should know that.”
“Everything has a generic name. That does not mean that there is a generic equivalent to the brand name product available.”
“But, $365.00 is ridiculous.”
“I agree, but I can’t influence the copay.”
“You pharmacists make too much money.”
Oh oh! You will be proud of Jay Pee. I took a swig of my Diet Coke and drew a long breath. “Doctor, I will assure you that there are very few pharmacies in the United States rolling in profits.”
“Oh, that’s rich,” she laughed. I did some checking of pricing. She is a pediatrician. “I prescribe Questran in Eucerin all the time and my patient’s moms complain about the price. I checked and the prices around here (South Houston) go from $50.00 to $150.00. That’s ridiculous.”
“That’s a compound,” I said.
“A what?”
“It has to be mixed.”
“So? One packet of Questran and a few ounces of Eucerin. Those can’t be expensive.”
“It isn’t the ingredients. It is the compounding that costs.”
“That much?”
“Of course. The only people who are trained to compound are pharmacists. We learned it in school and we perfected our techniques as we gained experience.”
I paused, but she was silent. So, I continued. “Doctor, I have been a pharmacist for a long time. I learned compounding when one of every ten prescriptions had to be mixed. I have compounded papers, capsules, suppositories as well as creams and ointments. I am good at it, even though my talents are rarely called upon in the 21st Century.”
“But, $150.00?” Oh, she was smug.
“Doctor, you charge for YOUR education, knowledge and experience. Why shouldn’t pharmacists? I have compounded the Cholestyramine/Eucerin prescription. If you were the mom, you would like my product. It is creamy and non-gritty. It is as elegant as the best cosmetic products. It turns out that way because I WAS trained in the 1960s. I have a learned talent, doctor and I AM NOT GIVING IT AWAY.”
I was getting loud. The technician to my left was smiling and nodding. She gave me a thumbs up sign. I lowered my voice. “You are a physician. There is never a second thought that you should charge for your knowledge and experience. Why shouldn’t a pharmacist charge for her knowledge and experience?”
Later, I called the prescriber back and told the receptionist that I needed to speak with the doctor. The message I conveyed about the $365.00 “copay” was that this mom had a $500.00 deductible on her prescription insurance.
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Although it is not our responsiblity to call the insurance and investigate the reasons for copays, I will usually try to do it in a case like this. Having a tech give a call to the insurance could have prevented the confusion and drama. Or, I would have instructed the patient to call the insurance and ask them why the copay was so high. Either option would have prevented the call to the physician. In my experience a copay is never $350. When the price comes back that high, something else is going on; deductable, donut hole, plan exclusion, etc. On a different note, Pulmicort was generic at my place for about three months and then not available. I hate when I generic comes out and then is pulled off the market. Recent examples- Oxycontin and Catapress TTS.
It is funny how this whole matter came about because the patient did not know they had a deductable. Now, whose responsibility is it for knowing and keeping up with their deductables? Is it the physician? Is it the pharmacist? As far as I am concerned, the patient can pay for the med or not, take it or leave it, and if the price is more than they expect then they can phone the insurance company. I don’t work for the insurance company and I don’t like being their puppet. Sure….get all google eyed and feel all “altruistic”, go “help” that patient, by YOU calling the insurance company, by you spending 20 minutes on the phone trying to hash out the situation…spend your day “helping” all these folks with THEIR insurance…be the insurance company puppets. For the most part, I just don’t have time to try and answer peoples questions about their copay. It is the DAMN insurance company that is setting the copay. It is their insurance…they can call!!!
Do you think I got my message across?
Couldn’t one also point out that compounding takes time, and that time is money?
Student, a pharmacist’s time is worth about a dollar a minute. That can be measured. Add a fee, overhead and you get $1.50 a minute. There are skills in play that cannot be measured. ONLY A PHARMACIST IS CAPABLE OF PREPARING A COMPOUND. Technicians who compound are pharmacist-trained. This is our thing. We need to hold it high and value it. Flaunt it and CHARGE FOR IT.
Peon, it takes you 20 minutes to hash it out with the insurance? I can deal with most insurance in under four minutes flat, and I keep working the entire time (bluetooth). It’s NOT our job but I help when I can. Call me crazy but I find satisfaction in helping our patients.
Rick, You are providing services, gratis, for the insurance company. You are in essence, their lackey. You are also taking good valuable time (a shortage in a busy pharmacy) away from the person or persons waiting for your services.
As you play into the scheme that the insurance companies have so adroitly woven for pharmacists, you are perpetuating a unfair situation for yourself and your peers.
I’m not knocking your desire to help,but being a unpaid pawn for the insurers is not in your best interest nor the long-term interests of the patient. Who’s going to do their insurance work for them when you are out of a job due to some insurance company or PBM raking away all of the profitability in pharmacy?
Ask that same person if they would give their time to you, at their place of employment, free of charge.
I was a chemist for 20 years before becoming a pharmacist. I am a master compounder. I had a maggot who worked for state medicaid question my fee, telling me my capsules were only worth about nine dollars a hundred, because the raw ingredients only cost about a dollar. I asked the maggot if he could make capsules. He hemmed and hawed, and I said “If you can come into my pharmacy and make a hundred capsules that are consistent and elegant, then I will accept your opinion.” He never showed. I love it when the patient says, “The doctor says this should be about twenty dollars…” I tell them, “Have your doctor make it…”
Sumotoad, I love it. Your writing is as elegant as your products. Phat, above, talks about the editorial page. I suggest that every pharmacist, who values her/his unique professional talent, write a note explaining just why compounded Tamiflu liquid costs a bit and why some products, like yours Sumotoad, will be elegant (and that word is the word my professor used in “Galenicals” and “Dispensing”) and others might be chunky. The elegant product must be worth more than the chunky one. Like the difference in a Starbucks latte and one made by machine at McDonalds. (What was McD thinking? It is an embarrassment). Compounding is all ours. When you got it, you can flaunt it… with attitude.